Thrombogenic risk in patients with atrial fibrillation: Importance of comorbid conditions and intracardiac changes

Han S. Lim, Scott R. Willoughby, Carlee Schultz, Muayad Alasady, Geetanjali Rangnekar, Jerry Dang, Cheryl Gan, Dennis H. Lau, Kurt C. Roberts-Thomson, Glenn D. Young, Matthew I. Worthley, Prashanthan Sanders

Research output: Contribution to journalArticle

10 Citations (Scopus)


Objectives This study sought to determine the differences between the prothrombotic properties and chamber characteristics in patients with lone atrial fibrillation (AF) and those with AF and comorbidities. Background Thromboembolic risk is increased in patients with AF; however, whether this is due to AF per se or its comorbidities remains unclear. Methods A total of 87 patients undergoing ablation were prospectively recruited for the study, including 30 patients with lone AF, 30 patients with AF and comorbidities in sinus rhythm, and 27 patients with left-sided accessory pathways as controls. Blood samples were obtained from the left atrium (LA), right atrium (RA), and femoral vein (FV) after transseptal puncture. Platelet activation (P-selectin) was measured by flow cytometry. Thrombin generation (thrombin-antithrombin [TAT] complex), endothelial dysfunction (asymmetric-dimethylarginine [ADMA]), and platelet-derived inflammation (soluble CD40 ligand [sCD40L]) were measured using enzyme-linked immunosorbent assay. Results Platelet activation in the LA was significantly elevated compared to that in the FV in patients with lone AF and those with AF and comorbidities compared with that in the FV (p < 0.05 respectively). Thrombin generation was significantly elevated in the LA compared with RA in AF patients (p < 0.05). There were no significant differences in P-selectin, TAT, and sCD40L among the 3 groups. However, there was a significant stepwise increase in endothelial dysfunction measured by ADMA from controls to lone AF and then to patients with AF and comorbidities (p < 0.001 between the 2 groups). Conclusions Patients with lone AF and those with AF and comorbidities had a greater propensity for atrial thrombogenesis than controls. Prothrombotic risk is greatest in those with comorbid conditions, in whom enhanced thrombogenesis occurs predominantly through increase in endothelial dysfunction.

Original languageEnglish
Pages (from-to)210-217
Number of pages8
JournalJACC: Clinical Electrophysiology
Issue number3
Publication statusPublished - 1 Jan 2015


  • atrial fibrillation
  • endothelial dysfunction
  • left atrium
  • stroke prevention
  • thrombotic risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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